In The Netherlands, the close relationship between doctor and patient over time can be viewed as an advantage in protecting the patient. Is it possible to implement this aspect of euthanasia in the United States?

In the wake of a pilot study that indicated that the experience of medical education appears to Inhibit moral development In medical students, increased attention needs to be given to the structure of medical education and the Influence it has on medical students. Interest in ethics and moral reasoning has become widespread in many aspects of professional and public life. Society has exhibited great interest in the ethical issues confronting physicians today. Considerable effort has been undertaken to train medical students, interns, and residents In how to reason through medical-ethical dilemmas. Media attention has focused on Issues such as abortion, euthanasia, care of severely handicapped infants, organ transplantation, and so forth, producing heated debates in both the professional and lay literature over the morality of the various positions. The curriculum of medical education has paralleled and reflected this general Interest in medical ethics. Most medical schools now offer, and frequently require, course work in ethics. However, further research Is needed to better characterize and understand the relationship of medical education to moral development.

In 1991, the University of Pittsburgh Medical Center (UPMC) implemented a policy that permitted the recovery of organs from cadavers pronounced dead using standardized cardiac criteria (Non-Heartbeating Cadavers or NHBC). This policy allowed families that had made a decision to forgo life sustaining treatment to then request organ donation. This entailed taking the patient to the operating room, discontinuing therapy (typically but not necessarily a ventilator), and after the patient is pronounced dead, procuring organs.

An urgent need for standards and guidelines on genetic testing has arisen because of swift advances in research, facilitated by the Human Genome Project. The goals of the Human Genome Project include the identification of all genes and sequencing of the human genome. The project is currently ahead of schedule and under budget. We can expect an avalanche of genetic information, much of which will be relevant to human disease. In addition to the Human Genome Project, investigator-initiated research projects and commercial biotechnology laboratories are discovering human disease genes at a breathtaking pace. Technology transfer has been rapid and has led to the availability of numerous clinical tests within only a few years since the first disease gene yielded to the technique of positional cloning. Disease genes are selected for study for a number of reasons. Genes for rare diseases may be studied before more common disorders because they elucidate an important area of pathogenesis. Unfortunately, technology transfer to the clinic for rare tests is hindered by several factors. Standards need to be established to assure that genetic tests for rare diseases are not ignored or mismanaged in the rush to commercialize tests for more common human genetic diseases.

A personable teenager with Down's syndrome became a Canadian cause célèbre a few months ago when University Hospital in Edmonton, Alberta, denied him a position on the organ transplantation waiting list. Terry Urquart lacked “reasonable” intelligence, hospital officials said, a criterion for all transplant candidates at that hospital. Protests by the boy's family, and by groups active in the cause of those with developmental disabilities, became well-photographed stories on the nightly television news and in the nation's newspapers. It did not hurt the Urquart cause one bit that the 17-year-old teenager had won a gold medal in skiing at the International Special Olympics.

The following description is based upon an actual case in which a patient initiated legal action after suffering a complication subsequent to an invasive diagnostic procedure performed by a senior fellow. Named as codefendants were the senior fellow, attending physician, and the hospital. Because any hospital with house staff is potentially vulnerable to similar litigation, Ethics Committees at Work is addressing the questions raised by this dilemma.

Ongoing legislative proposals to overhaul United States immigration policy look very much like a new wave of nativism is sweeping the Congress. The movement, mounted in early 1995, is in full swing to limit immigrant populations from arriving, settling, producing, and benefiting as our parents' generations have done. Legislators and the courts are now considering the most complete antiimmigration social legislation since the decades following the First World War.

Hospital ethics committees in The Netherlands have had the unique responsibility of developing euthanasia policies for their institutions. Although each policy necessarily reflects a particular facility, family resemblances necessarily remain. In the interest of ethics committees outside The Netherlands that may soon face the same challenge, two such policies are presented here accompanied by commentary high-lighting their similarities and differences.

Over the past year the debate over physician-assisted death has been waged in several courts and legislatures, and before at least one electorate as well. Measure 16, the Oregon Death With Dignity initiative that would permit physician-assisted suicide in some circumstances, was approved by the electorate; but it remains on hold while a permanent injunction issued against it by a Federal judge is reviewed by the United States Court of Appeals. Another Federal court judge's decision that the Washington statute criminalizing physician-assisted suicide was unconstitutional when applied to the case of a competent terminally ill patient in intractable pain, was reversed by a three judge panel of that same United States Court of Appeals.